【摘要】 目的 观察超声引导下经胸微创封堵治疗小儿缺损上缘距主动脉瓣≤2 mm膜周部室间隔缺损的有效性。方法 回顾性分析2017年3月-2023年8月安徽省儿童医院收治的110例缺损上缘距主动脉瓣≤2 mm膜周部室间隔缺损的患儿，根据手术方式分为外科组（n=61）和封堵组（n=49）。外科组施行传统体外循环下修补手术治疗，封堵组给予超声引导下经胸微创封堵治疗。记录两组的手术时间、呼吸机辅助时间、重症监护治疗时间、手术总出血量、术后住院时间、围术期并发症及术后6个月超声心动图参数。结果 封堵组患儿的手术时间、呼吸机辅助时间、术后住院天数均短于外科组[61.8(49.8,77.4)min比140.0(130.0,160.0)min、100.0(67.5,120.0)min比210.0(175.0,240.0)min、4.0(3.0,5.0)d比6.0(6.0,6.0)d，均P<0.05]；封堵组手术中位总出血量少于外科组[0.0(0.0,62.5)ml比115.0(90.0,140.0)ml,P<0.05]；术后两组并发症发生率无显著差异（P>0.05）；术后6个月与治疗前相比，两组患儿左心室舒张末径均下降（P<0.05），两组心律失常发生率，封堵组0%，外科组6.6%，无显著差异（P>0.05），封堵组新发瓣膜反流发生率大于外科组（8.2%比0%,P<0.05）。结论 超声引导经胸封堵治疗缺损上缘距主动脉瓣≤2 mm膜周部室间隔缺损的患儿，对于不合并主动脉瓣反流的病例，疗效满意，是一种安全、可行的术式。更多还原

【Abstract】 Objective To observe the effectiveness of ultrasound-guided thoracoscopic minimally invasive occlusion therapy for the treatment of perimembranous ventricular septal defects with the upper margin of the defect ≤2 mm from the aortic valve in children. Methods A retrospective analysis was conducted on 110 children with perimembranous ventricular septal defects with the upper margin of the defect ≤2 mm from the aortic valve admitted to Anhui Provincial Children’s Hospital from March 2017 to August 2023. The patients were divided into a surgical group(n=61) and an occlusion group(n=49) based on the surgical approach. The surgical group underwent traditional repair surgery under extracorporeal circulation, while the occlusion group received ultrasound-guided thoracoscopic minimally invasive occlusion therapy. The operation time, ventilator assistance time, intensive care unit stay time, total intraoperative blood loss, postoperative hospital stay, perioperative complications, and echocardiographic parameters at 6 months postoperatively were recorded for both groups.Results The operation time,mechanical ventilation time and the postoperative hospital stay in the occlusion group were significantly shorter than the surgery group [61.8(49.8, 77.4) min vs. 140.0(130.0, 160.0) min、100.0(67.5, 120.0) min vs. 210.0(175.0, 240.0) min、4.0(3.0, 5.0) d vs. 6.0(6.0, 6.0) d, all P<0.05]. The median total blood loss was less in the occlusion group than in the surgery group [0.0(0.0, 62.5) ml vs. 115.0(90.0, 140.0) ml,P<0.05]. The incidence of postoperative complications has no significant difference between the two groups(P>0.05). There was no significant difference in the incidence of arrhythmia between the two groups(P>0.05). The incidence of new valvular regurgitation in the occlusion group was higher than that in the surgery group(8.2%vs. 0%, P<0.05). Conclusion Ultrasound-guided transthoracic occlusion for children with perimembranous ventricular septal defects with the upper edge of the defect ≤2 mm from the aortic valve. For cases without combined aortic valve regurgitation, the therapeutic effect is satisfactory. It is a safe and feasible surgical method.更多还原